Rare good news in the battle to restore sanity at the American Psychiatric Association writes Martin Whitely MLA at www.speedupsitstill.com

On May 2, 2012, the American Psychiatric Association announced changes to its proposed DSM5.1 Psychosis Risk Syndrome, or as it was officially proposed to be called, Attenuated Psychosis Syndrome, has been dropped. This is great news because as has been highlighted at www.speedupsitstill.com on numerous occasions, Psychosis Risk Disorder was a flawed concept with the potential to be an iatrogenic health disaster. (Note: In coming weeks I will write an extended blog describing the history of Psychosis Risk Disorder and how this disaster was averted)

Additional good news is that most of the dangerous changes proposed for the already absurdly broad ADHD diagnostic criteria have been abandoned. An additional four alternative ADHD criteria had been identified for inclusion in the DSM5. They were:

1- Tends to act without thinking, such asstarting tasks without adequate preparation or avoiding reading or listening to instructions. May speak out without considering consequences or make important decisions on the spur of the moment, such as impulsively buying items, suddenly quitting a job, or breaking up with a friend.

2- Is often impatient, as shown by feeling restless when waiting for others and wanting to move faster than others, wanting people to get to the point, speeding while driving, and cutting into traffic to go faster than others.

3- Is uncomfortable doing things slowly and systematically and often rushes through activities or tasks.

4- Finds it difficult to resist temptations or opportunities, even if it means taking risks (A child may grab toys off a store shelf or play with dangerous objects; adults may commit to a relationship after only a brief acquaintance or take a job or enter into a business arrangement without doing due diligence).2

It is good news that these ridiculous additions have been removed along with the extremely worrying proposal to lower the bar for anyone over 16 years so that exhibiting 4 criteria of a subtype instead of 6 could be enough to get a diagnosis of ADHD. However, the existing 18 diagnostic criteria have been reworded to be equally applicable to adults as well as children, reflecting the ADHD industries persistent and successful efforts to expand the adult market.3

Another remaining concern is the proposal for an ADHD category titled Attention Deficit/Hyperactivity Disorder Not Elsewhere Classified must be removed. This additional category reads: Attention Deficit/Hyperactivity Disorder (ADHD) Not Elsewhere Classified may be coded in cases in which the individuals are below threshold for ADHD or for whom there is insufficient opportunity to verify all criteria. However, ADHD-related symptoms should be associated with impairment, and they are not better explained by any other mental disorder.4 The inclusion of this additional category effectively enables clinicians to diagnose and prescribe without even the flimsy protection offered by the already extremely broad DSM4 diagnostic criteria. It cannot be allowed to stand unchallenged.

While the back-downs from the original DSM5 proposals for Psychosis Risk, ADHD and a number of other dubious disorders are welcome they do not begin to go far enough. Continued pressure through protest and common-sense advocacy must be brought to bear on the American Psychiatric Association (APA). (Note: To comment directly to the American Psychiatric Association on their proposals click on http://www.dsm5.org/Pages/Registration.aspx)

The APA only responded after significant past users of the DSM, including the British Psychological Association and chapters of the American Psychological Association threatened a boycott of DSM5.5 This demonstrates that the APA’s DSM development process is driven by politics and money, rather than science and patient welfare. If their proposals were scientifically robust they would have defended them rather than compromising when the going got tough.

The resistance of DSM5 must continue. Ideally Australia should reject the permanent disability model of mental health embedded in the DSM and develop a model of treating mental illness designed to enhance individual resilience and assist the natural capacity of most mentally ill people to make a full recovery.

Continuing to follow the APA’s lead, will unnecessarily doom many more Australians to a vicious cycle of difficult personal circumstances, behavioural difficulties, dumbed down labelling, inappropriate prescribing and further prescribing to manage adverse side effects.